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Admission of liability in claim against King’s College Hospital NHS Foundation Trust for delay in management of Cauda Equina Syndrome

Posted: 09/06/2021

The specialist Cauda Equina team within the wider Penningtons Manches Cooper clinical negligence practice has recently secured admissions of liability in relation to a client who has suffered permanent neurological dysfunction as a result of various unacceptable delays in his management after he presented at the emergency department at Princess Royal University Hospital in February 2018.

Despite attending with and reporting signs and symptoms of Cauda Equina Syndrome which should have raised clinicians’ suspicions and subsequently prompted them to take urgent steps to confirm or exclude the diagnosis (he had some numbness and altered sensation in his ‘saddle’ area and altered bladder sensation and function), it was several hours before he was reviewed by a member of the orthopaedic team. His symptoms should then have resulted in an urgent MRI scan being arranged, but instead a lumbar x-ray was performed (which would not assist in the diagnosis of Cauda Equina Syndrome) and it was almost 36 hours from attendance before he underwent an MRI scan. 

The MRI scan confirmed Cauda Equina compression but, despite the trust’s neurosurgical team at King’s College Hospital being contacted once the results became available, it was almost another 24 hours before the patient was transferred to neurosurgical care and another few hours after that before he underwent surgery. During the period of hospital admission and delay there was documented further deterioration of his neurological function and, despite surgery, he has since been left with affected lower limb strength and function and bladder, bowel and sexual dysfunction. 

After investigations and input from independent medical experts, a claim was presented to King’s College Hospital NHS Foundation Trust (the trust covering both hospitals concerned) alleging failures on the part of both hospitals to manage the patient with appropriate urgency given his presentation. It was alleged that with appropriate care he should have had surgery during the afternoon of the day that he first attended the emergency department and, as that would have been within a fairly short window (less than 24 hours) after the onset of his Cauda Equina compression, he would have made a full recovery from his neurological dysfunction. 

A claim was submitted on that basis and the trust has recently responded. Whilst not all of the allegations of negligence have been admitted and there remains some dispute as to the timescale within which the surgery would have been performed with appropriate care, the trust has acknowledged that there were unacceptable delays in the claimant’s treatment and that these adversely affected his outcome. The parties will now proceed to consider the outstanding issues between them and value the claim with a view to negotiating settlement in due course.

Philippa Luscombe, head of the Cauda Equina team, comments: “This is yet another case where a patient presented with ‘red flag’ symptoms of Cauda Equina Syndrome and should have undergone urgent MRI imaging and then had arrangements made for emergency surgery – instead, there was a complete failure to manage his care with appropriate urgency. Cauda Equina Syndrome is a surgical emergency because of the well-known implications of prolonged compression of the Cauda Equina nerves. The outcome for our client has been fairly devastating and all the more frustrating because he attended hospital in the early stages and with correct care had every chance of a good outcome. It is appreciated that the trust has acknowledged some of the failings in his care and we hope that a sensible settlement can be achieved.”

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